• Item type: Scientific article
• Language: English
• Author: Lukas Schwingshackl, Sofia Dias and Georg Hoffmann
• Publication Date: , 2014
• 2046-4053-3-130.pdf(461.25 KB)

Background:

The aim of this meta-analysis was to compare the long-term efficacy of diet plus exercise (D + E) vs. diet (D), D + E vs. exercise (E) and D vs. E on anthropometric outcomes and cardiovascular risk factors in overweight and obese participants.

Methods:

Electronic searches were performed in MEDLINE and the Cochrane Central Register of controlled trials. Inclusion criteria were as follows: body mass index ≥25 kg/m2 and a minimum intervention period including follow-up of ≥12 months. Outcomes of interest were as follows: anthropometric parameters, blood lipids, blood pressure and cardiorespiratory fitness. Pooled effects were calculated using pairwise random effects and Bayesian random effects network meta-analysis. Results of the corresponding fixed effects models were compared in sensitivity analyses.

Results:

Overall, 22 trials (24 reports) met the inclusion criteria and 21 (including 3,521 participants) of them were included in the quantitative analysis. As compared with D, D + E resulted in a significantly more pronounced reduction in body weight [mean differences (MD): −1.38 kg, 95% confidence interval (CI) −1.98 to −0.79], and fat mass (MD: −1.65 kg, 95% CI −2.81 to −0.49], respectively. When comparing D + E with E, MD in change of body weight (−4.13 kg, 95% CI −5.62 to −2.64), waist circumference (−3.00 cm, 95% CI −5.81 to −0.20), and fat mass (−3.60 kg, 95% CI −6.15 to −1.05) was in favour of combined diet and exercise, respectively. Comparing E vs. D, diet resulted in a significantly more pronounced decrease in body weight (MD: −2.93 kg, 95% CI −4.18 to −1.68), and fat mass (MD: −2.20 kg, 95% CI −3.75 to −0.66). D + E yielded also the greatest reductions with respect to blood lipids and blood pressure when compared to single applications of D and E, respectively. Results from the network meta-analyses confirmed these findings.

Conclusions:

Moderate-quality evidence from the present network meta-analysis suggests that D + E can be highly recommended for long-term obesity management. Furthermore, the evidence suggests a moderate superiority of D over E with respect to anthropometric outcomes.